CQC inspections are a lottery for many, says law firm

UK healthcare providers are facing a lottery over inspections by their regulator, the Care Quality Commission (CQC), with huge variations in enforcement decisions by different inspectors, says commercial law firm EMW.

CQC data shows that in 2013/14, 16 inspectors took ‘enforcement action’, the most severe option, in which they can fine, close or even prosecute, in more than 20% of all healthcare premises they inspected. In sharp contrast, 176 inspectors gave a ‘pass’ to every provider they inspected. In the same period, EMW says that many health and social care providers believe the outcomes of CQC inspections are inconsistent, as the broadly-drafted regulations force inspectors to make a subjective judgement, with very little audit of those decisions. It warns that the extensive enforcement powers granted to the CQC in 2014, as well as a raft of new powers set to be introduced this year, including the power to oversee providers’ financial affairs, make it increasingly important that CQC inspectors are as accurate as possible in their assessments.

EMW principal Joe Soul said some health and social care providers felt CQC inspectors’ widely varying interpretations of the regulations had made inspections a lottery.

“Both the statutes and the care standards that underpin the CQC’s work are drafted so broadly that making inspections clearly objective is virtually impossible, and there is little sign of any auditing of individual inspectors’ decisions,” said Mr Soul.

“There has also been considerable pressure on the CQC from politicians and the media to uncover more underperforming providers, and avoid more scandals like those involving the Winterbourne View and Ash Court care homes.”

Shortfall in expertise

EMW adds that the CQC’s problem of inconsistency is exacerbated by the regulator’s piecemeal origins, and recruitment and training policies, saying some CQC staff are former Ofsted inspectors, some are former care workers, and others were previously employed by Primary Care Trusts.

“When an inspector has the power to close down a provider, as well as levy fines and prosecute, you would expect them to have the appropriate expertise, and to be making their assessments against clearly objective standards,” said Mr Soul.

“The current situation creates a risk that not only could some providers be punished unduly, but also that patients’ interests could be harmed by excessively lenient inspections.

“It also raises the concern over how much expertise the organisation possesses in regulating providers’ financial affairs, as it is expected to gain that power this year.

“A more robust and uniform training programme for CQC inspectors, a more unified recruitment policy, and a carefully-planned approach to deploying existing staff would all be excellent first steps in solving the problem.”